Coercion in mental healthcare does not only affect the patient, but also the patient’s families. Using data from interviews with 36 family members of adult and adolescent people with mental health problems and coercion experiences, the present narrative study explores family members’ existential and moral dilemmas regarding coercion and the factors influencing these dilemmas. Four major themes are identified: the ambiguity of coercion; struggling to stay connected and establishing collaboration; worries and distress regarding compulsory care; and dilemmas regarding initiating coercion. Subsequently, coercion can reduce, but also add burden for the family by creating strains on family relations, dilemmas, (moral) distress, and retrospective regrets; this is reinforced by the lack of information or involvement and low-quality care. Subsequently, it is a moral obligation to develop more responsive health services and professionals who provide more guidance and balanced information to increase the possibilities for voluntary alternatives and informed decision making.

Aims and objectives: To describe what and why nurses self-disclose to patients in mental health care. Background: Self-disclosure is common, but controversial and difficult to delineate. Extant research suggests that self-disclosure might have several potentially beneficial effects on therapeutic alliance and treatment outcome for patients in mental health care, but results are often mixed and limited by definitional inconsistencies. Method: Qualitative descriptive study including data from 16 nurses taking part in participant observation, individual interviews and focus group interviews. Results: Separate analyses resulted in four themes addressing the research question of what nurses self-disclose, and one main theme and four subthemes addressing why nurses self-disclose. The content of self-disclosure was captured in the four themes: Immediate family, Interests and activities, Life experiences, and Identity. In addition, results showed that disclosures were common among the nurses. Self-disclosure's potential to transform the nurse-patient relationship, making it more open, honest, close, reciprocal and equal, was the overarching reason why nurses shared personal information. The nurses also chose to self-disclose to share existential and everyday sentiments, to give real-life advice, because it felt natural and responsive to patients’ question to do so. Conclusion: Nurse self-disclosure is common and covers a variety of personal information. Nurses have several reasons for choosing to self-disclose, most of which are connected to improving the nurse-patient relationship. Relevance to clinical practice: Self-disclosure controversy can make it difficult for nurses to know if they should share personal information or not. Insights into the diversity of and reasons for nurse self-disclosure can help with deliberations on self-disclosure. Keywords: mental health nursing, nurse–patient relationship, professional boundaries, qualitative study, therapeutic relationships

Background: There is little research comparing clinicians’ and managers’ views on priority settings in the healthcare services. During research on two diffe rent qualitative research projects on healthcare prioritisations, we found a striking difference on how hospital executive managers and clinical healthcare professionals talked about and understood prioritisations. Aim: The purpose of this study is to explore how healthcare professionals in mental healthcare and somatic medicine prioritise their care, to compare different ways of setting priorities among managers and clinicians and to explore how moral dilemmas are balanced and reconciled. Research design and participants: We conducted qualitative observations, interviews and focus groups with medical doctors, nurses and other clinical members of the interdisciplinary team in both somatic medical and mental health wards in hospitals in Norway. The interviews were recorded and transcribed verbatim. Ethical considerations: Basic ethical principles for research ethics were followed. The respondents signed an informed consent for participation. They were assured anonymity and confidentiality. The studies were approved by relevant ethics committees in line with the Helsinki Convention. Findings: Our findings showed a widening gap between the views of clinicians on one hand and managers on the other. Clinicians experienced a threat to their autonomy, to their professional ideals and to their desire to perform their job in a professional way. Prioritisations were a cause of constant concern and problematic decisions. Even though several managers understood and empathised with the clinicians, the ideals of patient flow and keeping budgets balanced were perceived as more important. Discussion: We discuss our findings in light of the moral challenges of patient-centred individual healthcare versus demands of distributive justice from healthcare management. Conclusion: The clinicians’ ideals of autonomy and good medical and nursing care for the individual patients were perceived as endangered. Keywords Areas of practice, clinical ethics, empirical approaches, ethics and leadership/management, ethics of care/ care ethics, intensive care, mental health/psychiatry, moral/ethical climate of organisations, professional ethics, qualitative research, theory/philosophical perspectives, topic areas

This study was initiated to examine how experiences with mental illness are perceived by health care workers and how insight affects assessment of their perspective and involvement. Lack of insight gives rise to problems concerning communication: If we expect what the person says and does not to have any meaning, how then can we establish relationship with based on understanding? This study was based on in-depth interviews with 11 mental healthcare workers. Participants were recruited from a variety of institutions and professional backgrounds. The following topics were discussed with the participants: lack of insight, awareness of illness, and coping strategies, as well as how these factors affected treatment, cooperation, and participation. The participants describe attuned understanding as an other-oriented process, involving sensitivity to many aspects of the person’s situation. Understanding is sought and is established through emotional, human contact and practical interaction and ends with new articulated understanding. The results suggest that the process described here can be viewed as other-oriented understanding and not merely sympathy. It is an interdependent process of imagining oneself in the other’s place and depends on awareness of the nature of this process and on sensitivity to the persons’ expressions. Keywords: Communication; Insight; Health Personnel; Patient Care; Professional-Patient Relations; Psychotic Disorders

The idea behind this article is to discuss the importance and to develop the concept of reciprocity in asymmetric professional relationships. As an empirical starting point for an examination of the possible forms of reciprocity between patients and nurses in psychiatry, we chose two qualitative in-depth interviews with two different patients. The manners in which these two patients relate to medical personnel—one is dependent, the other is independent—show that this presents challenges to nurses. The theoretical context is provided by the notion of mature care as it has been developed by feminist-oriented ethics of care, in contrast to the notion of altruistic care. In relation to the concept of mature care, we discuss how nursing can be perceived in demanding relationships with patients in psychiatry. Reciprocity implies that, in principle, the interests of the nurses also matter in a nurse-patient relationship. We show that reciprocity—in practice—is complicated and challenging in a number of different ways. Mature care—with its systematic inclusion of relationships and reciprocity—provides an alternative understanding of what takes place between patients and nurses compared with an altruistic notion of care. As such, mature care can be regarded as an useful paradigm for nurse-patient relationships in psychiatry.

Hem, Marit Helene; Skirbekk, Helge & Nortvedt, Per (2011). Different views on priority settings among clinicians and executive officers in Norwegian hospitals. Empirical findings from the study ”Mapping a normative terrain of an ethics of care”.

Hem, Marit Helene; Skirbekk, Helge & Nortvedt, Per (2011). Different views on priority settings among clinicians and executive officers in Norwegian hospitals. Empirical findings from the study”Mapping a normative terrain of an ethics of care”.